What are the symptoms of measles?

Symptoms of Measles

Measles is characterized by a generalized rash lasting ≥3 days, fever ≥38.3°C (≥101°F), and at least one of the following: cough, coryza (runny nose), or conjunctivitis. 1

Clinical Presentation Timeline

Prodromal Phase

• Initial symptoms appear 10-12 days after exposure
• High fever (≥38.3°C/≥101°F)
• The "3 Cs":
  • Cough
  • Coryza (runny nose)
  • Conjunctivitis (red, watery eyes)
• Koplik spots: pathognomonic small white spots on bright red background on buccal mucosa, appearing 1-2 days before rash 1, 2

Exanthematous (Rash) Phase

• Rash appears 3-4 days after fever onset
• Begins on face and behind ears
• Spreads cephalocaudally (head to foot)
• Becomes more confluent as it progresses
• Typically lasts ≥3 days 1, 2

Common Complications

Complications occur in 10-40% of patients 2 and include:

• Respiratory: Pneumonia, laryngotracheobronchitis
• Gastrointestinal: Diarrhea, stomatitis
• Ear infections: Otitis media
• Neurological (uncommon but serious):
  • Acute disseminated encephalomyelitis (during or soon after acute disease)
  • Measles inclusion body encephalitis (months later)
  • Subacute sclerosing panencephalitis (years later) 3, 4

High-Risk Populations

The following groups are at increased risk for severe complications:

• Infants and children under 2 years
• Adults
• Pregnant women
• Immunocompromised individuals 1

Laboratory Diagnosis

Laboratory confirmation of measles includes:

• Positive serologic test for measles IgM antibody
• Significant rise in measles antibody level by standard serologic assay
• Isolation of measles virus from a clinical specimen
• Detection of measles virus RNA by PCR 1

Blood should be collected during the first clinical encounter, though IgM may not be detectable until at least 72 hours after rash onset. If initial IgM testing is negative, repeat testing is recommended after 72 hours post-rash onset 1.

Management

Treatment is primarily supportive:

• Vitamin A supplementation (reduces mortality risk in children):
  • Children <12 months: 100,000 IU orally on days 1 and 2
  • Children >12 months: 200,000 IU orally on days 1 and 2 1
• Oral rehydration therapy for diarrhea with dehydration
• Antipyretics for fever management
• Nutritional support
• Antibiotics for secondary bacterial infections 1, 3

Prevention

Prevention through vaccination is critical:

• MMR vaccine is safe and effective
• Two doses recommended: first at 12-15 months and second at 4-6 years
• Post-exposure prophylaxis options:
  • MMR vaccine within 72 hours of exposure
  • Immune Globulin within 6 days of exposure for high-risk individuals 1

Infection Control

• Isolate infected individuals for at least 4 days after rash onset
• Use airborne precautions in healthcare settings
• Report suspected cases to public health authorities immediately 1

Despite being considered preventable, measles remains a major public health concern globally, causing over 100,000 deaths per year worldwide 5. The disease is highly contagious and transmitted through aerosols via human-to-human contact 5, 3.